[Problems in organizing neurosurgical care for patients with Parkinson's disease in the Russian Federation]. / Problemy organizatsii neirokhirurgicheskoi pomoshchi patsientam s bolezn'yu Parkinsona v Rossiiskoi Federatsii.

BACKGROUND: Currently, there are some problems in the Russian Federation complicating development of neurosurgical care for patients with Parkinson's disease (PD). MATERIAL AND METHODS: In 2022, neurologists - movement disorders specialists were surveyed to analyze situation with PD pharmacological treatment and referral of patients for surgical treatment in Russian constituent entities. Data on neurosurgical treatment of PD were obtained by collecting information on the surgical activity of medical institutions in the Russian Federation. Most hospitals involved in PD treatment took part in this study. RESULTS: The state of neurosurgical care for patients with PD is analyzed and possible ways to improve the quality of treatment are discussed. CONCLUSION: Over the past 20 years, a system of neurosurgical care for patients with PD has been formed in 14 centers in the Russian Federation (2022). Obstacles to its further development can be divided into 3 categories: problems of patient selection and routing, complexity of organization and financing surgeries, and imperfect postoperative patient management. Ways to overcome these obstacles imply expanding the network of centers for extrapyramidal diseases, development of domestic neurostimulation systems, improving the distribution of quotas taking into account the capabilities of hospitals, specialized training of neurologists for extrapyramidal centers and neurosurgeons for deep brain stimulation centers, adequate financing and systematization of postoperative management of patients with PD.

[Results of the Third Congress on Functional and Stereotactic Neurosurgery]. / Itogi Tret'ego kongressa po funktsional'noi i stereotaksicheskoi neirokhirurgii.

After several years of waiting due to the "covid quarantine" and subsequent restrictions, we finally met. Epidemiological restrictions prevented the planned interim congress in 2021. The Third Congress on Functional and Stereotactic Neurosurgery was held in Moscow on March 15-17, 2023. Despite the widespread use of the online conference format, the Congress was attended by almost everyone who is in one way or another associated with functional and stereotactic neurosurgery in our country. International participation was also present despite the existing sanctions restrictions.

[Mills' syndrome]. / Sindrom Millsa.

Mills' syndrome is an idiopathic, slowly progressive ascending spastic hemiparesis. Some authors consider it as a unilateral variant of progressive lateral sclerosis. Due to the rarity of the disease and the slow clinical course, this article presents a clinical case and discusses the diagnostic criteria for the syndrome.

[Communication with a neurological patient]. / Kommunikatsiya s nevrologicheskim patsientom.

Patient communication skills are critical for the management of neurological patients, in particular for discussing neurological diagnosis and prognosis. The key communication tools are SPIKES protocol for delivering «bad news¼ and the Calgary-Cambridge model. These communication tools allow to implement a patient-oriented approach to treatment, build effective communication with the patients, and thus provide them high-quality and personalized medical care.

[Progressive supranuclear palsy]. / Progressiruyushchii nad"yadernyi paralich.

Progressive supranuclear palsy (PSP) is a heterogeneous progressive neurodegenerative disease characterized by onset after 50 years old, Parkinson's syndrome, early development of postural instability, absence or transient reaction to levodopa drugs, neuropsychological disorders, dysphagia and dysarthria and eye movement disorders. The review provides an analysis of modern data on etiology, clinical presentation, differential diagnosis of the disease. The morphological picture and neuroimaging features, as well as modern ideas about treatment, are described. A great clinical polymorphism of the disease, as well as its similarity to other neurodegenerative diseases, manifested by Parkinson's syndrome, complicates the diagnosis of PSP. Establishing an accurate diagnosis makes it possible to determine the prognosis and further tactics of patient management.

[Palliative care in Parkinson's disease and neurodegenerative diseases]. / Palliativnaya pomoshch' pri bolezni Parkinsona i neirodegenerativnykh zabolevaniyakh.

Palliative care is traditionally associated with cancer and pain relief: however, the range of diseases requiring palliative care is much wider and includes many neurodegenerative diseases (Alzheimer's disease and Parkinson's disease (PD)). Provision of palliative care to patients with PD and other neurodegenerative diseases, such as multisystem atrophy, progressive supranuclear palsy, dementia with Lewy bodies, etc. is «terra incognita¼ for many neurologists who are not acknowledged with palliative medicine as well as for specialists in palliative medicine, who are mainly trained in providing care to patients with oncological profile and do not know the intricacies of managing patients in the late stages of PD and other neurodegenerative diseases. The aim of the article is to systematize modern knowledge in the field of palliative medicine and neurodegenerative diseases.

[Multifocal brain lesions]. / Mnogoochagovye porazheniya golovnogo mozga.

Despite the current laboratory and instrumental approaches to the diagnosis, a patient with multiple brain lesions remains a difficult one. The reason is that these lesions can be caused by a variety of disorders, including rare ones and atypical forms. Distinguishing neoplastic lesions from non-neoplastic CNS disorders is crucial due to different treatment options. The authors report the case of a patient with multiple brain lesions, present a literature review of diseases to be differentially diagnosed with multifocal brain lesions and suggest a simple algorithm for the differential diagnosis. Timely clinical evaluation and a multidisciplinary approach are required for making a definitive diagnosis that is extremely important to start the appropriate therapy.

[Deep brain stimulation effect on postural instability and gait disorders in Parkinson's disease]. / Narusheniia khod'by i postural'naia neustoichivost' pri bolezni Parkinsona na fone khronicheskoi stimuliatsii podkorkovykh struktur.

An effect of deep brain stimulation on postural instability and gait disorders in Parkinson's disease S.G. Sultanova, N.V. Fedorova, E.V. Bril, A.A. Gamaleya, A.A. Tomskiy During the last time, surgical treatment of patients with Parkinson's disease has firmly taken its place in the general algorithm for managing patients with this pathology. Deep brain electrostimulation is the most advanced and promising method, which allows the reduction in the severity of main clinical manifestations of the disease, including axial symptoms. It is noted that certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant. Subthalamic nucleus stimulation was also reported to improve levodopa-responsive freezing of gait. In this review, the authors summarize the effects of deep brain stimulation on gait and postural symptoms.

[Effects of bilateral deep brain stimulation in the subthalamic nucleus using two methods of target structure verification]. / Dinamika motornykh simptomov bolezni Parkinsona na fone khronicheskoi dvustoronnei élektrostimuliatsii subtalamicheskogo iadra s ispol'zovaniem dvukh metodik verifikatsii struktury misheni.

AIM: To evaluate the efficacy of deep brain stimulation in the subthalamic nucleus (DBS STN) in patients with Parkinson's disease (PD) using different methods of targeting according to the dynamics of motor symptoms of PD. MATERIAL AND METHODS: The study involved 90 patients treated with DBS STN. In 30 cases intraoperative microelectrode recording (MER) was used. MER was not performed in 30 patients of the comparison group. The control group consisted of 30 patients with PD who received conservative treatment. Hoehn and Yahr scale, Tinetti Balance and Mobility Scale (TBMS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Quality of Life-39 Scoring System (РDQ-39), Schwab & England ADL Scale were used. Levodopa equivalent daily dose (LEDD, 2010) was calculated for each patient. RESULTS AND CONCLUSION: The effect of DBS STN using intraoperative microelectrode recording on the main motor symptoms, motor complications, walking as well as indicators of quality of life and daily activities was shown. In both DBS STN groups, there was a significant reduction in the LEDD and marked improvement of the control of motor symptoms of PD. A significant reduction in the severity of motor fluctuations (50%) and drug-induced dyskinesia (51%) was observed. Quality of life and daily activity in off-medication condition were significantly improved in both DBS STN groups of patients, irrespective of the method of target planning (75-100%), compared with the control group.

[Syndrome dopamine dysregulation and deep brain stimulation of the subthalamic nucleus in Parkinson's disease]. / Sindrom dofaminovoi dizreguliatsii i khronicheskaia stimuliatsiia subtalamicheskogo iadra pri bolezni Parkinsona.

AIM: Dopamine dysregulation syndrome (DDS) is a complication of the dopaminergic therapy in Parkinson's disease (PD); it is manifested as a compulsive medication use and may have negative impact on patients' social, psychological, and physical functioning. An effect of deep brain stimulation in the subthalamic nucleus (DBS STN) on DDS is not fully understood. Therefore, the degree of DDS during DBS STN in PD patients was evaluated in the study. MATERIAL AND METHODS: The main group included 15 patients with DDS symptoms in the preoperative period. The comparison group consisted of 15 patients without DDS symptoms and the control group consisted of 15 patients who did not undergo surgery. RESULTS AND CONCLUSION: The severity of motor disturbances in the surgery groups has decreased significantly (by 45%). Motor complications during DBS STN in patients with DDS have decreased by 50%; a decrease in the reduction of doses of dopaminergic preparations was noted as well.

[Pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease]. / Medikamentoznaia terapiia na fone élektrostimuliatsii subtalamicheskogo iadra u patsientov s bolezn'iu Parkinsona.

AIM: To analyze pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus. MATERIAL AND METHODS: The study included 54 patients, who underwent bilateral STN DBS from 2003 to 2012. The severity of motor disturbances, activities of daily living and complications of dopaminergic therapy were estimated in accordance with II, III and IV parts of the Unified Parkinson's Disease Rating Scale (UPDRS) before operation and one, three and four years after it. L-dopa equivalent daily dose (LEDD) was assessed along with an analysis of the pharmacotherapy in whole. RESULTS AND CONCLUSION: By the end of the 1st year, the severity of motor disturbances in OFF-period decreased by 52.3% and remained stable for 3 years (51.8%), a slight increase of severity of motor disturbances was observed later, however it didn't reach the pre-operative level. The severity of motor fluctuations and drug-induced dyskinesia fell by 64.9%, 70.7% and 42.7% by the end of the first, third and fourth year of observation. The maximal decrease in LEDD was reached by the end of the 1st year and accounted for 57.7%; by the end of the third and fourth years it was 52.4% and 38.2%, respectively. During the 1st year, 16.7% of patients didn't take levodopa. The dose of pure levodopa decreased by the end of the 1st year by 64.6%, and by 56.7% and 43.7% by the end of the 3rd and 4th years, respectively. Monotherapy by an agonist of dopamine receptors (ADR) was received by 12.9% of patients, thus the share of ADR as part of the combined therapy increased in the postoperative period from 24.1% to 35.2%.

[A comparative study of the efficacy of deep brain stimulation of the subthalamic nucleus and pharmacological treatment in advanced Parkinson's disease]. / Sravnitel'noe issledovanie éffektivnosti neirokhirurgicheskogo lecheniia (élektrostimuliatsiia subtalamicheskogo iadra) i medikamentoznoi terapii na razvernutoi stadii bolezni Parkinsona.

Objective. To assess the clinical efficacy of deep brain stimulation (DBS STN) of the subthalamic nucleus in patients with Parkinson´s disease (PD) compared to pharmacological treatment. Material and methods. DBS STN was applied to 22 patients (mean age 53.2 years, mean disease duration 9,6 years). The control group included 28 patients (mean age 54.2 years, mean disease duration 9,6 years) with PD who received pharmacological treatment. Patients were examined in OFF-medication and ON-medication conditions at 3, 6, 9, 12, 24, 36 months. The Unified Parkinson's Disease Rating Scale (UPDRS) part II, III, IV, the Hoehn and Yahr scale, the Schwab and England Scale, PDQ-39, the Hamilton Rating Scale for depression and the Spielberger Anxiety Scale were administered. All patients had motor fluctuations and dyskinesias. Results and conclusion. We demonstrated that DBS STN improved UPDRS II, III scores, reduced dyskinesias and motor fluctuations. After surgery, dopaminergic therapy was reduced by approximately 54.5%. In the control group, levodopa dose was increased by 20.5% to 36th month.

[Electrostimulation of a subthalamic nuclear area in Parkinson's disease].

The paper presents the results of application of chronic electrostimulation of the subthalamic nucleus in 15 patients with the akinetic-rigid form of Parkinson's disease. Standard UPDRS, Schwab and England, Hoehn and Yahr, and PDQ-39 rating scales were used for the clinical evaluation of motor disorders. The patients were examined before and 6 months after surgery with ON-stimulation in OFF and ON-medication. Positive results as better life quality, ameliorated motor disorders, and fewer complication of drug therapy with a two-fold reduction in the daily dose of L-dopa were obtained in the vast majority of patients (n = 14).